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General NPI Number Information
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NPI Number | 1083579668
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Entity Type | Individual
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Provider Name | JOSEPH LANCE WILSON
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Gender | Male
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 4211 HOSPITAL ST
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City | PASCAGOULA
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State | MS
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Zip | 39581-5320
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Country | US
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Telephone | 228-282-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 WESTBROOK ST APT 67
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-4038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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